38119

FISS Narrative:
Bills for a continuous stay or admission must be submitted in the same sequence in which the services are furnished. If you have not already done so, please submit the prior bill, then resubmit this bill after you receive the remittance advice for the prior bill.

Explanation and Suggestion:

  • This reason code occurs when SNF inpatient claims are "out of sequence"
  • The claim receiving this reason code does not directly follow the thru date of the previous paid claim for this Medicare beneficiary from this provider
  • In many instances, the claim that breaks the sequential chain may be in process (check the Claims Inquiry screen #12 for a claim in Status S or T)
  • If so, the current claim cannot continue processing until the "in sequence" claim is paid (you receive the claim on a remittance advice)
  • If the "in sequence" claim is not already in FISS, it must be submitted and paid before the current claim can process

Contact Palmetto GBA JM Part A Medicare


Provider Contact Center: 855-696-0705

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